Spontaneous subdural hematoma associated with visceral leishmaniasis and HIV

Abstract

Subdural hematoma (HSD) is a type of intracranial hemorrhage commonly associated with trauma, but it can also be spontaneous. Spontaneous HSD is uncommon and typically associated with coagulopathy, neoplasia, and vascular malformations, among other factors. Although there is little description in the literature, thrombocytopenia may also be associated with HSD. Among the various etiologies for thrombocytopenia, infections such as human immunodeficiency virus (HIV) and visceral leishmaniasis (VL) should be considered in differential diagnosis. This report describes an unpublished case of spontaneous HSD secondary to thrombocytopenia by VL in a young man with well-controlled HIV, whose management included the use of liposomal amphotericin B (treatment of VL), atorvastatin, dexamethasone, and embolization of the middle meningeal artery (MMA) (measures for HSD). This case highliths the importance of comprehensive evaluation of patients with co-infections, to inform interventions that may be yield better benefits.